Peds Respiratory

what statement expresses accurately the genetic implications of cystic fibrosis? a. if it is present in a child, both parents are carriers of this defect b. it is inherited as an autosomal dominant trait c. it is a genetic defect found primarily in nonwhite population groups d. there is a 50% chance that siblings of an affected child will also be affected

A- recessive gene

the clinic nurse provides home care instructions to a mother regarding the care of her child who is diagnosed with croup. which statement by the mother indicates the need for further instructions? a. I will give Tylenol for fever b. I will give cough syrup ever night at bedtime c. sips of warm fluids during croup attach will help d. I will place a cool-mist humidifier next to my child's bed

B we do not want to suppress cough because it increases the risk of pneumonia cannot give under 12 years of age OTC cold medicine should not be used either

there are several children in the ER waiting area who all have asthma. the nurse has only one room left in the ER. based on the following information, which child should be seen first? a. 5 year old who is speaking in complete sentences, pink in color, wheezing bilaterally and has an oxygen saturation of 93% b. a 9 year old who is quiet, pale in color, wheezing bilaterally with oxygen saturation of 92% c. 12 year old who has a mild cry, pale in color, diminished breath sounds with an oxygen saturation of 93% d. a 16 year old who is speaking in short sentences, wheezing, sitting upright, an oxygen saturation of 95%

C diminished breath sounds

the nurse is assessing the skin moisture of a child with LTB. which of the following explains why the nurse assessed the skin moisture in this case? a. to get some measure of how dehydrated the child might become b. increased skin moisture will signal danger of ketoacidosis c. skin moisture is a relatively good measure of the degree of infection d. diaphoresis is associated with increased respiratory effort

D

cystic fibrosis may affect singular or multiple systems of the body. the primary factor responsible for possible multiple clinical manifestations is which of the following? a. atopic changes in mucosal wall of intestines b. hyperactivity of autonomic nervous system c. hyperactivity of sweat glands d. mechanical obstruction caused by increased viscosity of mucus secretions

D- thick mucus

what is the Childs epiglottis like?

floppy and vulnerable to swelling which increases risk of aspiration

clinical therapy for CF

focus: maintaining respiratory function chest physiotherapy daily with bronchodilator prior encourage exercise pulmonzyne- decreases viscosity of sputum but causes voice alterations avoid oxygen toxicity dose of antibiotics may be higher d/t increased metabolism (s/s of infection are diminished or absent) prevent GI blockage- behavioral therapy

cystic fibrosis

genetic recessive disorder of exocrine glands increased viscosity of mucus secreting glands all mucus membranes are affected decreased ability to regulate sodium and chloride channels

exercise induced asthma

gets worse 5-10 mins after stopping exercise worse on cold, dry days treatment: before exercise 10-15 minutes and use albuterol goal: not inhibit exercise- we want good control

diagnosis for cystic fibrosis

high RIT sweat chloride test have to wait until 4 weeks old may taste salty to caregivers 40-60 is suggestive >60 is diagnostic diagnosed in early infancy or childhood

digestion CF problems

impacted feces obstruction of pancreatic ducts excreted undigested food GI reflux PUD pancreatitis diabetes mellitus- d/t blocked pancreatic ducts stool characteristics- undigested food, fatty, foul, frothy

pulmonary TB

in lungs more symptomatic cough, weight loss, fever, chills, wheezing, decreased lung sounds

latent TBI

in the body but immune system has deactivated bacteria asymptomatic

promoting nutrition and preventing GI blockage in CF

increase fluids increase sodium intake (regular formula does not have the sodium requirements needed) 120-150% calories of daily allowance high protein, moderate fats multivitamin that is non-fat soluble pancreatic enzymes with all meals and large snacks lactulose (remember: identity v. role confusion)

important things about cystic fibrosis

increase sodium intake when exercising pulmozymes decrease sputum viscosity high calorie diet, moderate fats, high protein lactulose prescribed to decrease intestinal obstruction chest physiotherapy may be prescribed 2-4 times per day

what does increased airway resistance cause in children?

increased risk of complications and infections

disseminated TB/extrapulmonary TB

infants and young children commonly spread from lungs to body through blood or lymph system

tuberculosis

infection that can affect lungs and other tissues when immune system cannot fight off highest risk: foreign born, hispanics, Asians

otitis media

inflammation of inner ear s/s: pulling, pushing, rubbing ear, won't lay on affected side, hearing impairment during acute <3 years are very vulnerable acute- flu and strep most common effusion- fluid chronic- beyond 3 months

epiglottitis

inflammation of the epiglottis medical emergency due to bacterial invasion of soft tissue of larynx most common in 2-8 year olds

bronchitis

inflammation of trachea and bronchi usually occurs with another condition commonly during winter months treatment is usually palliative unless d/t bacterial infection s/s: dry and hacking cough, chest and rib soreness, coarse breath sounds with fine crackles

pneumonia

inflammation or infection of the bronchioles and alveolar spaces community or hospital accquired viral mycoplasmal or bacterial mycoplasma- no cell wall, usually antibiotic resistant

bronchiolitis

lower respiratory infection from viral or bacterial RSV is the most common cause transmission through respiratory secretions and contaminated surfaces

what is the determining factors of severity of asthma?

lung function severity of exacerbations symptoms and frequency frequency of short acting beta 2 agonists and corticosteroid use awakenings at night interruptions of ADLs

reproductive CF problems

males- absence of vas deferens, low sperm count females- thick vaginal discharge, decreased cervical secretions STIs are still a risk so educate

BPD treatment

manage symptoms- prone, decrease respiratory rate trach needed often times increase caloric intake chest physiotherapy medications- antibiotics only for prophylaxis

peak flow meter

measurement of max speed of expiration marker at lowest number stand up take deep breath seal lips and blow out hard and fast repeat 2 more times record highest number coughing alters reading blowing out cheeks or tongue in the way alters reading

treatment for croup

monitor for hypoxia supplemental oxygen resemic epi (nebulized epi) for decreasing mucosal swelling helox- decreases airway turbulence and easier to inhale corticosteroids fluids cool mist therapy limit time on bottle to 20-25 mins

bronchopulmonary dysplasia

need for supplemental oxygen for at least 28 days after premature birth results from PEEP and oxygen treatment for respiratory failures not a disease- caused from ventilator requires trach d/t alveoli stretched out and scarred tachypnea, nasal flaring, grunting, retractions, wheezing, crackles, irritability

is occlusion of the nares or oral cavity uncommon in small children?

no- very common

do children have the same oxygen stores as adults?

no-less

what should be taught to parents when their child is placed in an oxygen tent?

open it as little as possible due to air leaking

RSV facts

prematurity is a risk factor younger than 3 months is predictor of severity supplemental oxygen is main treatment riboflavin used with only high risk cases and no pregnant women can administer bronchodilators and steroids often used but will not fix problem Synagis is used as a monthly injection to prevent RSV- have to have gestational age requirements and O2 therapy for 28 days prior

tonsillectomy and adenoidectomy

preop- how old they are postop- side lying, watch for frequent swallowing, do not blow nose or cough, all secretions need to be analyzed, no carbonated or acidic food, no straws, soft diet for 3 weeks healed at 3 weeks stay at home for 7 days only performed on 3 years and older d/t blood loss and risk of growing back clots form and pull off days 4-10 post op (highest risk of hemorrhage

does lymph tissue grow rapidly or slowly in early childhood?

rapidly

what medication is given for patients who are at high risk for RSV, but cannot be administered by a pregnant woman?

riboflavin

foreign body aspiration

sudden onset choking, spasmodic cough, SOB, dysphonia due to inhalation of object into respiratory tract

treatment of bronchiolitis/RSV

supportive care due to usually viral isolate to decrease spread of infection hydration oral or IV humidified O2, nasal suction before feeds and after giving saline bullet resemic epi, albuterol, nebulized saline chest physiotherapy

personal best for asthma

taken over 2-3 weeks when child is feeling good no exacerbations green zone 80%-90% pretty good yellow zone 50%-80% need treatment red zone <50% get to hospital use this to develop action plan and give to child and parent

maintenance for asthma

theophylline inhaled corticosteroids (Flovent) leyukotrine modifiers- montekulast hydration oxygen close to hospitals follow-up education on triggers and meds

a child presents with a sore throat, fever of 102.3, and difficulty swallowing. What condition should be considered?

tonsillitis and pharyngitis

SIDS

unexplained death in sleep of baby 2-4 months of age has highest risk 1st and only symptom is cardiopulmonary arrest autopsy is the only way to diagnose increased risk: parents smoking, not well ventilated room, history of SIDS, co-sleeping, blankets, pillows, stuffed animals in crib, placing baby on stomach

croup syndromes

viral or bacterial upper airway illness worse at night d/t not being able to cough up secretions worse in winter months s/s: stridor, barking cough, respiratory distress

s/s of RSV/bronchiolitis

wheezing increased effort of breathing tachycardia tachypnea flaring nostrils retractions decreased O2 grunting *decreased wet diapers and decreased appetite*

is a childs neck shorter than an adults?

yes

is it uncommon to see a sinus infection in children younger than age 7?

yes

when does the Childs respiratory tract stop growing and changing?

age 12

s/s of pneumonia

air hungry decreased appetite nasal flaring retractions adventitious lung sounds restlessness

MDI with spacer

always use with corticosteroids to help it get to lungs and not stay in the mouth educate on how to use shake inhaler between teeth and seal lips exhale, press, inhale slowly and deeply and hold for 5 seconds

treatment for pneumonia

antibiotics airway management fluids to increase circulation rest pain and fever control

when are croup symptoms worse?

at night-often managed at home

rescue meds for asthma

beta 2 agonists (albuterol)- open bronchioles corticosteroids- prevent histamine anticholinergics- Spiriva, atrovent- prevent muscle tightening

the nurse is caring for a 10 month old infant with RSV. which intervention should be included in the child's care? SATA a. administer antibiotics b. administer cough syrup c. encourage to drink 8 oz of formula every 4 hours d. cluster care to encourage adequate rest e. place on noninvasive oxygen monitoring

c, d, e fluids always decrease secretions, rest helps to decrease O2 requirements, pulse ox for respiratory illnesses always

triggers of asthma

cause release of histamine lining of airway is inflammed muscles tighten and mucus production increases airways are narrowed and more difficult to move air air trapping results can be life threatening Phase 1 to Phase 2 makes it more difficult to breathe

apnea

cessation of respirations for longer than 20 seconds obstructive central mixed prematurity apparent life-threatening events

asthma

chronic and very common hyper-responsive airways bronchial constriction airway inflammation easier to prevent than treat multifactorial

tonsillitis and pharyngitis

common in childhood and usually viral infection children are prone s/s: sore throat, difficulty swallowing, fever tx: supportive care

respiratory CF manifestations

cough sputum thick alveolar hyperinflation hemoptysis digital clubbing hypoxia respiratory acidosis chronic sinusitis barrel chest frequent infections

treatment for epiglottis

do not examine throat airway management with intubation decrease anxiety and never reposition antibiotics hydration emotional support do not ask open ended questions-they cannot speak well

what are the 4 Ds of epiglottis?

dysphonia, drooling, difficulty breathing, dysphagia

when is the respiratory smooth muscles complete development?

1 year old

active TB

10 years and younger are rarely contagious d/t small lesions and inability to cough up mucus fever, cough, chills, weight loss

how much higher is the metabolic demands and oxygen consumption in an infant and young child compared to an adult?

200% or higher

s/s of epiglottis

abnormal position dysphagia/drooling difficulty speaking apprehension/anxiety increased temperature rapid onset nasal flaring use of accessory muscles retractions stridor enlarged epiglottis *frog like croak* air hunger